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Have you ever given a patient money?

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  •  Kamban 
    Participant
    Status: Physician
    Posts: 1788
    Joined: 08/01/2016
    Earnest refinancing bonus

    We have many long standing patients and some of them fall on hard times unexpectedly. A widow living on social security had a house fire and also had a major car repair. The insurers were dragging their feet. All she asked for was if she can pay her outstanding balance a bit later. Not only did we agree but I also gave her a check (personal) for $300 to help out with her car repair. She literally broke into tears at the gesture.

    Over a year she paid off her bills as her insurance money started to trickle through. She continued to remain our patient till she died.

    I have given smaller amounts to others too and written off bills from really poor patients or not charged some of them at all. I just consider it a form of charity, maybe my way of contributing the 10% of my income that some here do.

    #179651 Reply
    portlandia portlandia 
    Participant
    Status: Physician
    Posts: 274
    Joined: 07/07/2017

    …How are we supposed to have long term interactions with patients and not form deep attachments

     

    Click to expand…

    By that logic, I guess we should date or flirt with patients too. Hmmmm 🙂

    The answer to your question is by having (or seeking) the attachments, friendships, etc which you need in your personal life. You have two worlds, two personas, two sets of ethics, etc. That is the very core nature of professionalism.

    That professionalism concept will make it easy to set appropriate professional boundaries and deter you from looking for – or responding to – affection or attachment in your professional life. There is nothing wrong with empathy and building rapport with patients, but if you try to take on the world, do realize that the world can get pretty heavy. At the end of the day, they’re your health care clients. Nothing more, certainly nothing less. Don’t let it get personal… better for the patients and staff that way (Dr. Even Keel >>> Dr. Heart-on-Sleeve) and much better for you in that you can easily mentally decompress from work and enjoy your hobbies and pursuits once you leave the hospital for time off.

    It is a huge undertaking just to be a high functioning individual, add happiness and health to others, and lead by example in your professional life. It is even bigger to do all that and then have good fitness or social or family or community life in your personal time. You can’t fight other people’s battles for them (and they won’t learn anything if you did). GL

    Click to expand…

    One gigantic strawman of the argument I was making.

    #179653 Reply
    Liked by Tim, ENT Doc
     HikingDO 
    Participant
    Status: Physician
    Posts: 221
    Joined: 03/09/2017

    I’m somewhat surprised and saddened by some of the answers so far, though it is understandable especially if giving money to patients is considered by institutions as “unprofessional behavior”, as in the linked article. Is this a commonplace corporate response to physician giving? Can one be fired for this? What would state medical boards say about physician giving? Would one’s license be at risk? What has happened to medicine? Where has the family doc and FRIEND gone to? Is being a physician supposed to entail only a “professional” and not a personal relationship? How are we supposed to have long term interactions with patients and not form deep attachments, that would move us from time to time to help in ways that are beyond a strict physician-patient interaction? How is giving money to someone in need “unprofessional?” Is that the kind of profession we want?

    Recently I had a patient with a dying family member in another state who could not afford to fly to see them. I struggled with the decision of whether to help (patient did not ask for my help) and if I could do it in an anonymous way and one that would not breach some ridiculous standard like the ones cited here. In the end, I dithered and the family member died and my patient and friend never got to say goodbye. Although I feel terrible about my decision, I guess I am supposed to feel like I did the right thing?

     

    Click to expand…

    The family doc as a friend died along time ago, right about the same time that Marcus Welby and respect for our profession did. It died when HMOs started, and when patient started reviewing and grading us on Yelp by the speed of our care instead the quality of it, and bash us on Vitals.com if we don’t give antibiotics or URIs and Percocet for acute “back pain”. It died when lawsuits increased, and when we started to have to practice defensive medicine so that we don’t get sued for missing the occasional zebra. It died when patients have no issue with calling me on call at 3:00am because their blood pressure meds run out this morning and they want to make sure  that I call it in for them before they miss their evening dosage, even though they haven’t been to the office for over a year. I don’t live in an Ivory Tower anymore like I did when I first left residency, however I’ll do my best to care for their appropriate medical needs and be kind to them, but in no way am I their friend.

    #179657 Reply
    Liked by Zaphod, G
     Panscan 
    Participant
    Status: Resident
    Posts: 352
    Joined: 03/18/2017

    Why is it your responsibility to make sure the friend gets there? physicians as a whole have this complex of like making everything their responsibility and I don’t think it’s productive. Vs everyone else who has canned replies for assigning blame like “it’s a systems issue.”

    #179658 Reply
    Liked by Zaphod
    jfoxcpacfp jfoxcpacfp 
    Moderator
    Status: Financial Advisor, Accountant, Small Business Owner
    Posts: 6347
    Joined: 01/09/2016

    I’m somewhat surprised and saddened by some of the answers so far, though it is understandable especially if giving money to patients is considered by institutions as “unprofessional behavior”, as in the linked article. Is this a commonplace corporate response to physician giving? Can one be fired for this? What would state medical boards say about physician giving? Would one’s license be at risk? What has happened to medicine? Where has the family doc and FRIEND gone to? Is being a physician supposed to entail only a “professional” and not a personal relationship? How are we supposed to have long term interactions with patients and not form deep attachments, that would move us from time to time to help in ways that are beyond a strict physician-patient interaction? How is giving money to someone in need “unprofessional?” Is that the kind of profession we want?

    Recently I had a patient with a dying family member in another state who could not afford to fly to see them. I struggled with the decision of whether to help (patient did not ask for my help) and if I could do it in an anonymous way and one that would not breach some ridiculous standard like the ones cited here. In the end, I dithered and the family member died and my patient and friend never got to say goodbye. Although I feel terrible about my decision, I guess I am supposed to feel like I did the right thing?

     

    Click to expand…

    The family doc as a friend died along time ago, right about the same time that Marcus Welby and respect for our profession did. It died when HMOs started, and when patient started reviewing and grading us on Yelp by the speed of our care instead the quality of it, and bash us on Vitals.com if we don’t give antibiotics or URIs and Percocet for acute “back pain”. It died when lawsuits increased, and when we started to have to practice defensive medicine so that we don’t get sued for missing the occasional zebra. It died when patients have no issue with calling me on call at 3:00am because their blood pressure meds run out this morning and they want to make sure  that I call it in for them before they miss their evening dosage, even though they haven’t been to the office for over a year. I don’t live in an Ivory Tower anymore like I did when I first left residency, however I’ll do my best to care for their appropriate medical needs and be kind to them, but in no way am I their friend.

    Click to expand…

    Really? Is this your perception of all patients? That makes me kind of sad. I don’t think that attitude is prevalent in Mayfield, KY yet.

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~ 270-247-0555
    https://fox-cpas.com/for-doctors-only/

    #179663 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 1197
    Joined: 01/03/2017

    I’m somewhat surprised and saddened by some of the answers so far, though it is understandable especially if giving money to patients is considered by institutions as “unprofessional behavior”, as in the linked article. Is this a commonplace corporate response to physician giving? Can one be fired for this? What would state medical boards say about physician giving? Would one’s license be at risk? What has happened to medicine? Where has the family doc and FRIEND gone to? Is being a physician supposed to entail only a “professional” and not a personal relationship? How are we supposed to have long term interactions with patients and not form deep attachments, that would move us from time to time to help in ways that are beyond a strict physician-patient interaction? How is giving money to someone in need “unprofessional?” Is that the kind of profession we want?

    Recently I had a patient with a dying family member in another state who could not afford to fly to see them. I struggled with the decision of whether to help (patient did not ask for my help) and if I could do it in an anonymous way and one that would not breach some ridiculous standard like the ones cited here. In the end, I dithered and the family member died and my patient and friend never got to say goodbye. Although I feel terrible about my decision, I guess I am supposed to feel like I did the right thing?

     

    Click to expand…

    The family doc as a friend died along time ago, right about the same time that Marcus Welby and respect for our profession did. It died when HMOs started, and when patient started reviewing and grading us on Yelp by the speed of our care instead the quality of it, and bash us on Vitals.com if we don’t give antibiotics or URIs and Percocet for acute “back pain”. It died when lawsuits increased, and when we started to have to practice defensive medicine so that we don’t get sued for missing the occasional zebra. It died when patients have no issue with calling me on call at 3:00am because their blood pressure meds run out this morning and they want to make sure  that I call it in for them before they miss their evening dosage, even though they haven’t been to the office for over a year. I don’t live in an Ivory Tower anymore like I did when I first left residency, however I’ll do my best to care for their appropriate medical needs and be kind to them, but in no way am I their friend.

    Click to expand…

    Really? Is this your perception of all patients? That makes me kind of sad. I don’t think that attitude is prevalent in Mayfield, KY yet.

    Click to expand…

    I doubt it is but I will say that visits with ridiculous expectations (whether in the ED or the outpatient setting) are very prevalent. Sometimes after a shift, I feel pretty jaded because I don’t remember the good interactions but the few bad ones stand out. It can certainly make one jaded pretty fast.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #179666 Reply
    Liked by Tim, HikingDO
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 1737
    Joined: 05/01/2017

    Why is it your responsibility to make sure the friend gets there? physicians as a whole have this complex of like making everything their responsibility and I don’t think it’s productive. Vs everyone else who has canned replies for assigning blame like “it’s a systems issue.”

    Click to expand…

    That’s why we should be proud to be physicians.

    Patients don’t get better or get good care until someone takes ownership of them.

    The buck stops with us, and the vast majority of us really care.

    Personally, I celebrate that.

    #179668 Reply
     HikingDO 
    Participant
    Status: Physician
    Posts: 221
    Joined: 03/09/2017

    I’m somewhat surprised and saddened by some of the answers so far, though it is understandable especially if giving money to patients is considered by institutions as “unprofessional behavior”, as in the linked article. Is this a commonplace corporate response to physician giving? Can one be fired for this? What would state medical boards say about physician giving? Would one’s license be at risk? What has happened to medicine? Where has the family doc and FRIEND gone to? Is being a physician supposed to entail only a “professional” and not a personal relationship? How are we supposed to have long term interactions with patients and not form deep attachments, that would move us from time to time to help in ways that are beyond a strict physician-patient interaction? How is giving money to someone in need “unprofessional?” Is that the kind of profession we want?

    Recently I had a patient with a dying family member in another state who could not afford to fly to see them. I struggled with the decision of whether to help (patient did not ask for my help) and if I could do it in an anonymous way and one that would not breach some ridiculous standard like the ones cited here. In the end, I dithered and the family member died and my patient and friend never got to say goodbye. Although I feel terrible about my decision, I guess I am supposed to feel like I did the right thing?

     

    Click to expand…

    The family doc as a friend died along time ago, right about the same time that Marcus Welby and respect for our profession did. It died when HMOs started, and when patient started reviewing and grading us on Yelp by the speed of our care instead the quality of it, and bash us on Vitals.com if we don’t give antibiotics or URIs and Percocet for acute “back pain”. It died when lawsuits increased, and when we started to have to practice defensive medicine so that we don’t get sued for missing the occasional zebra. It died when patients have no issue with calling me on call at 3:00am because their blood pressure meds run out this morning and they want to make sure  that I call it in for them before they miss their evening dosage, even though they haven’t been to the office for over a year. I don’t live in an Ivory Tower anymore like I did when I first left residency, however I’ll do my best to care for their appropriate medical needs and be kind to them, but in no way am I their friend.

    Click to expand…

    Really? Is this your perception of all patients? That makes me kind of sad. I don’t think that attitude is prevalent in Mayfield, KY yet.

    Click to expand…

    No, not all, but it’s not just perception since I’ve been practicing FM for 20+ years so I’ve seen my share. Most of my time has been in corporate owed clinics, so admittedly I’ve become a bit jaded, but respect works both ways, and in the last 20 years respect for our profession has taken a nosedive. Maybe docs in Mayfield, KY are lucky, but docs here in big city Southwest are not.

    #179669 Reply
    Liked by Tim
     Antares 
    Participant
    Status: Physician
    Posts: 410
    Joined: 01/20/2016

    I have a schizophrenic patient I have seen for 25 years. I know him well and we have a good relationship. One day he forgot cab money to get home from my office. I gave him 20$, which he returned to me the next week.

    No sequelae, I was happy to help under these circumstances, it worked for him. No I don’t give needy patients money. But my point is that the circumstances matter, and here I found one in which I was comfortable giving (lending) a patient a small amount of money.

    #179677 Reply
     Panscan 
    Participant
    Status: Resident
    Posts: 352
    Joined: 03/18/2017

    Why is it your responsibility to make sure the friend gets there? physicians as a whole have this complex of like making everything their responsibility and I don’t think it’s productive. Vs everyone else who has canned replies for assigning blame like “it’s a systems issue.”

    Click to expand…

    That’s why we should be proud to be physicians.

    Patients don’t get better or get good care until someone takes ownership of them.

    The buck stops with us, and the vast majority of us really care.

    Personally, I celebrate that.

    Click to expand…

    I agree to a certain degree but then it has limits. Who do you pick and choose? as an ED doc you’re probably seeing hundreds of impoverished patients a year.

    #179687 Reply
    wonka31 wonka31 
    Participant
    Status: Physician
    Posts: 367
    Joined: 03/24/2018

    Multiple times. I once gave a person a ride home (nice older lady, husband couldn’t derive at night due to vision, couldn’t find a cab). These circumstances have to be unique, but I have and will again in the future I’m sure.

    #179690 Reply
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 1737
    Joined: 05/01/2017

    Why is it your responsibility to make sure the friend gets there? physicians as a whole have this complex of like making everything their responsibility and I don’t think it’s productive. Vs everyone else who has canned replies for assigning blame like “it’s a systems issue.”

    Click to expand…

    That’s why we should be proud to be physicians.

    Patients don’t get better or get good care until someone takes ownership of them.

    The buck stops with us, and the vast majority of us really care.

    Personally, I celebrate that.

    Click to expand…

    I agree to a certain degree but then it has limits. Who do you pick and choose? as an ED doc you’re probably seeing hundreds of impoverished patients a year.

    Click to expand…

    I’m not saying I hand out cash to impoverished patients, I don’t and I think in general it’s not a great idea.

    You mentioned a “complex” physicians have about making things our responsibility. I think this is a feature not a bug and is a defining characteristic of the profession.

    How many patients have you taken care of in residency already who would have been screwed if you hadn’t just said (tacitly or explicitly) “ok I’m going to take care of this.”

    #179695 Reply
    Liked by Anne, Tim, wonka31
     Panscan 
    Participant
    Status: Resident
    Posts: 352
    Joined: 03/18/2017
    WCICon18

    Why is it your responsibility to make sure the friend gets there? physicians as a whole have this complex of like making everything their responsibility and I don’t think it’s productive. Vs everyone else who has canned replies for assigning blame like “it’s a systems issue.”

    Click to expand…

    That’s why we should be proud to be physicians.

    Patients don’t get better or get good care until someone takes ownership of them.

    The buck stops with us, and the vast majority of us really care.

    Personally, I celebrate that.

    Click to expand…

    I agree to a certain degree but then it has limits. Who do you pick and choose? as an ED doc you’re probably seeing hundreds of impoverished patients a year.

    Click to expand…

    I’m not saying I hand out cash to impoverished patients, I don’t and I think in general it’s not a great idea.

    You mentioned a “complex” physicians have about making things our responsibility. I think this is a feature not a bug and is a defining characteristic of the profession.

    How many patients have you taken care of in residency already who would have been screwed if you hadn’t just said (tacitly or explicitly) “ok I’m going to take care of this.”

    Click to expand…

    I’m with ya, I’m just saying it’s hard to pick who you should help and who you shouldn’t

    #179703 Reply
    Liked by Anne
     jz 
    Participant
    Status: Physician
    Posts: 599
    Joined: 01/09/2016

    I gave pts. money 4-5 times from the ER.  I gave rides home 3 times.  Never any adverse events, and I once received a thank you card.

    #179713 Reply
    Liked by hatton1, Anne
     shantster 
    Participant
    Status: Physician
    Posts: 88
    Joined: 01/16/2016

    To the original question: I don’t. I have been tempted several times but have resisted. Honestly I am most tempted not by the saddest cases but by things that would streamline dispo. Example a homeless pt w/ cellulitis who could be rx’ed w/ a $4 rx from Target but repeatedly states they won’t leave b/c they don’t have money to fill it. I have been tempted but haven’t given in.

    It helps that my shop is loaded and tends to have lots of resources to deal with this — vouchers, SW assistance etc.

    Click to expand…

    Your hospital doesn’t have any prescription medication benefit? Our uninsured patients get a free 30 day supply of medications at hospital discharge. There are some limitations on the medications they have but they carry most common things.

    #179722 Reply

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